Celiac Plexus Block
Clinical Applications
The celiac plexus block can be combined with intercostal block
to provide anesthesia for intra-abdominal surgery (see Chapter
73
). Because it results in blockade of the autonomic nervous system, this
block may help to reduce stress and endocrine responses to surgery.
Anatomy and Technique
The celiac plexus contains visceral afferent and efferent fibers
derived from T5 to T12 by means of the greater, lesser, and least splanchnic nerves.
The plexus has no somatic fibers and is composed of a number of ganglia and nerve
fibers. It innervates most of the abdominal viscera. Knowledge of the surrounding
structures is important for correct needle placement. The plexus lies in close relation
to the L1 vertebra. The vena cava lies anteriorly to the right, and on the left
anteriorly is the aorta. The kidneys lie laterally, with the pancreas anterior.
The number of ganglia varies from one to five, and each ganglion is 0.5 to 4.5 cm
in diameter. Left-sided ganglia are usually lower than those on the right.
Bony surface landmarks can be reliably used for needle placement.
With the patient in the prone position and with a pillow beneath the abdomen, lines
are drawn connecting the spine of T12 with points 7 to 8 cm lateral at the lower
edges of the 12th ribs. These lines form a flattened isosceles triangle, the equal
sides of which serve as directional guides for the needles ( Fig.
44-28B
). A 20-gauge, 10- to 15-cm needle is inserted on the left side
through a skin wheal at a 45-degree angle toward the body of T12 or L1. Bony contact
should be made at an average depth of 7 to 9 cm. The needle is then withdrawn and
is reinserted to allow the tip to slide off the vertebral body anterolaterally.
The needle is advanced 1.5 to 2 cm past this point; aortic pulsations can be felt
as they are transmitted along the needle when it is correctly placed (see Fig.
44-28
). After this depth is ascertained, the right-sided needle is inserted
in a similar fashion to a depth of 1.0 to 1.5 cm farther (see Fig.
44-28A
). When the needles are in position, observation for leakage of
blood, urine, or cerebrospinal fluid is made before careful aspiration. A 3- to
5-mL test dose of local anesthetic is given before injection of 20 to 25 mL of solution
through each needle.
Figure 44-28
A, For a celiac plexus
block, the needle is inserted at a 45-degree angle toward the body of L1. The tip
slides off the vertebral body anterolaterally and is advanced 1.5 to 2 cm. A, aorta;
IVC, inferior vena cava. B, Patient positioning and
surface landmarks for a celiac plexus block.
Side Effects and Complications
Side effects associated with celiac plexus block include hypotension;
spinal, epidural, or intravascular injection; pneumothorax; puncture of viscera (e.g.,
kidney, ureter, gut); and retroperitoneal hematoma.
